How Ovarian Cancer is Diagnosed

While there are several tests and procedures that can lead doctors to suspect ovarian cancer, surgery is the only way to make a definitive diagnosis.

Before going down the path of diagnosis, it’s important to understand that symptoms are not always present with ovarian cancer. A good baseline is to understand and discuss family history and risk factors with a physician. The most common ovarian cancer symptoms include bloating, difficulty eating or feeling full quickly, pelvic or abdominal pain, and/or urinary frequency lasting for more than two weeks. There are common misconceptions about what routine procedures detect ovarian cancer. For starters, while annual check ups and pelvic exams are a good check for a general baseline of reproductive health, it should be noted that ovarian tumors are usually too small for this to be a method of detection. 

Types of tests used to detect ovarian cancer include surgery, CA-125, OVA1, CT Scan and TVUS.
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Ovarian cancer cannot be diagnosed through a Pap smear. A Pap smear, common in an annual gynecologic exam, only screens for cervical cancer. 

To detect ovarian cancer, a physician may order the following imaging tests such as ultrasounds or blood work to gain insights as to what may be causing the symptoms.

Physical and Gynecologic Exams

Ovarian cancer is unlikely to be discovered during a routine physical or gynecologic exam. Because of its location within the body, an ovarian tumor is not easily felt during a pelvic exam, unless the tumor is large. Ovarian cancer also does not have an early detection or screening tool to be administered during an annual exam. Still, physical and gynecologic exams play an important part in diagnosing ovarian cancer: they are a first step toward more definitive imaging tests and surgical procedures that can detect and begin treating ovarian cancer. They are also the first step in pursuing genetic counseling and testing – an important tool to help identify those at high risk for ovarian cancer, so they may consider taking action to reduce their risk.

If you are concerned about your ovarian cancer risk, or are experiencing symptoms, schedule an exam and talk to your doctor about ovarian cancer.

Imaging Tests for Ovarian Cancer Diagnoses

If a doctor suspects ovarian cancer, they may order imaging tests including a CT scan, transvaginal ultrasound, or both. Imaging tests are a relatively non-invasive tool to help identify whether there is a mass in the ovaries or pelvic area, and if a mass appears to be potentially malignant. Imaging tests alone cannot confirm an ovarian cancer diagnosis.

Computerized Tomography (CT) Scan

CT scans employ x-rays to take multiple cross-sectional images of the tissues and bones in the body. Doctors can analyze the images or use software to make a three-dimensional model of the internal organs. If present, a CT scan helps define the boundaries of a cancerous tumor and show the extent of tumor spread, helping a doctor determine where to operate. 

Transvaginal Ultrasound (TVUS)

A transvaginal ultrasound uses sound waves to create an image or video on a screen. It’s often the first test done and can indicate if there is a mass on the ovaries, and if that mass is solid, showing a tumor, or fluid-filled, indicating a cyst. A TVUS can also be used to get a better look at the ovary, to see if anything could potentially be a concern. 

X-ray

An x-ray produces cross-body imaging using a type of radiation called electromagnetic waves. X-rays are rarely used in first diagnosing ovarian cancer, but they are sometimes used to see if cancer has spread elsewhere in the body. A chest x-ray can display tumors in the lungs, and fluid that has collected near the lungs, known as pleural effusion.

MRI Scan

An MRI, short for magnetic resonance imaging, is similar to an X-ray, except it does not use radiation. An MRI uses magnetic radio waves to produce images of the inside of the body. MRIs are rarely used to check for ovarian cancer initially, though they can be used to examine the spinal cord and the brain, where cancer can sometimes spread.

Surgical Procedures for Ovarian Cancer Diagnoses

A surgical biopsy is the only way to definitively diagnose ovarian cancer. Laparoscopies and laparotomies, though invasive surgical procedures, are similar to imaging tests in that they are performed to give physicians a closer view of the ovaries and surrounding region, and can aid in planning debulking surgery or biopsy.

Laparoscopy or Laparotomy

In a laparoscopy or laparotomy, a physician can examine the ovaries and other pelvic organs by using a thin tube that sends the images of the region to a video monitor. The major difference is that in the laparoscopy, the physician will use multiple, smaller incisions, while a laparotomy will use a singular, larger incision. Both procedures give a view that can better examine the cause of discomfort, how large tumors have grown and aids in planning surgeries or other treatments. In rare cases, during these procedures, the surgeon can also perform a biopsy. 

Biopsy

The only way to definitively determine if a patient has ovarian cancer is through a biopsy. This is when tissues from a tumor are removed and tested in a lab. For an ovarian cancer diagnosis, in most cases, biopsies are guided by an ultrasound or CT scan, but in some situations where there is a concern that the biopsy could spread the cancer due to its advanced stage, or there’s another serious medical condition present, the biopsy can be done during a laparoscopy or laparotomy. 

Blood Tests for Ovarian Cancer Diagnoses

There is no blood test that can diagnose ovarian cancer. But certain blood tests, including OVA1, and tests that measure Inhibin B and Inhibin A, and CA-125, can be used to estimate risk level, staging, or progression of disease.

OVA1

To aid in risk stratification, the process of determining what risk level someone has of developing ovarian cancer, OVA1 blood test has been approved by the Food and Drug Administration (FDA). The test measures the levels of five proteins in blood that change when ovarian cancer is present. However, this test has not been approved for use as an ovarian cancer screening tool, nor has it been proven to result in early detection or reduce the risk of death from this disease. Instead, it’s utilized to help determine if surgery should be done by a gynecologist or a gynecologic oncologist. 

Inhibin B and Inhibin A

Specifically granulosa cell tumors are most often detected and/or monitored through Inhibin B and Inhibin A indicators. This is another test a physician may ask for to potentially diagnose ovarian cancer. 

CA-125

Another blood test that can be ordered is for CA-125, which is a protein in the blood that is often elevated in women with ovarian cancer. It should be noted that CA-125 can be elevated in people with benign conditions, so the National Cancer Institute does not endorse using it as an ovarian cancer screening tool for those who are at ordinary risk of developing ovarian cancer. 

Once diagnosed with ovarian cancer, there are more tests and procedures to confirm the stage of the diagnosis and direct health care professionals to the best course of treatment. As with all cancers, early detection goes a long way, so it is critical patients have annual check ins with their gynecologist and open conversations about family health histories to see if there is an increased risk of the disease.